Chlamydia: the cruel fertility thief

Some of the young women have never even heard of the disease that threatens to sterilize them. They wonder, in their classic youthful way, how this possibly could be happening to them.

Chlamydia is not in their frame of reference.

"Some are so surprised because they've only been with one or a few partners. They say, 'Oh, I really should have used a condom, huh?' " says Dr. Ruth Krause, chief of women's health at Group Health Cooperative.

But chlamydia, one of the most common sexually transmitted diseases, has been steadily increasing in King County and Washington state, especially among young women aged 15 to 24. In frequency of occurrence, it is the STD of early sexuality.

"The take-home message is if you're out there and having sex, you can have a chlamydia infection and have no symptoms whatsoever," says Margery Osborn-O'Dom, a nurse practitioner at the Kent teen clinic of Public Health-Seattle & King County.

More than three-fourths of women and about half of men have no early symptoms of chlamydia. Thus, they are not tested and treated with an antibiotic that can quickly cure the infection.

For women, that is especially dangerous because left untreated, chlamydia can cause pelvic inflammatory disease, which can lead to infertility, a dangerous tubal pregnancy or chronic pelvic pain. The disease also can infect babies in the birth canal, harming their lungs and causing them to develop pneumonia.

Where to get tested Testing for sexually transmitted diseases is available through private physicians and a variety of clinics. Public Health-Seattle & King County clinics The STD clinic at Harborview Medical Center: 206-731-2271. Teen Health Clinics: Visit www.metrokc.gov/health/locations/ teens.htm or call 206-205-7837. Family Planning Clinics: www.metrokc.gov/health/famplan/ famschd.htm or call 206-205-7837. Other clinics Community clinics, Planned Parenthood and Gay City (for gay or bisexual men) For more information: www.metrokc.gov/health/apu/std/ wheretest.htm

Men with chlamydia can have inflammation of the testicles, also leading to infertility. And in both sexes, the disease causes small breaks in the tissue, increasing the risk of HIV infection.

No one knows for sure why chlamydia, after plateauing in the mid-1990s, has been on a steady, gradual increase in King County and statewide for more than six years.

Some experts speculate more infections are occurring because the fear of AIDS has diminished as modern drugs enable people to live much longer with HIV. Many are willing to take more risks, not using condoms and having more sexual partners.

Others attribute the increase in Washington state to more widespread screening in urban areas with tests that pick up the disease better than ever. The test is done with a urine sample.

"I think we don't really know" the reason for the increase, said Dr. Matt Golden, acting director of STD control for Public Health-Seattle & King County.

In 2003, cases of chlamydia increased to 5,168 in King County, nearly 17,000 in Washington state and nearly 835,000 nationwide. All were increases over the previous year, and women far outnumbered men. In King County, for example, twice as many women as men were diagnosed with the infection last year.

The Centers for Disease Control and Prevention has long recommended annual chlamydia tests for sexually active women age 25 and younger and says all pregnant women should be tested. Public Health urges testing for pregnant women and women age 24 and younger, those with a new sexual partner and those who do not use condoms consistently.

State Department of Health officials also encourage young men to be tested, but not many heed the call. Typically, they seldom see a physician unless injured, while young women often are asked to take the test when they go to a doctor for birth-control measures.

Several years ago, the State Department of Health advertised to young males in four counties. Posted in schools, movie theaters and other locations, the slogan was: "Got lucky? Got anything else? Get tested!" But the campaign raised testing levels only slightly, said Mark Aubin, of the Health Department's STD services division.

Chlamydia symptoms in both females and males may include painful urination and lower abdominal pain. Females may have vaginal discharge, painful intercourse and spotty bleeding between menstrual periods. Men may have a discharge from the penis and testicular pain.

Just three weeks ago, the CDC reported that the recommended testing of women nationwide was low: Only 26 percent of young women with commercial health insurance and 38 percent on Medicaid receive the tests.

The agency said some doctors may underestimate the prevalence of disease in young people, don't believe they are sexually active or are uncomfortable discussing sexual activity. Patients may not request the test because of the stigma of an STD, they don't know they can have an infection without symptoms and a parent may be present at their clinic appointment.

King County health officials have aggressively urged testing, sending letters to all doctors and clinics. They encourage doctors to have patients return for a second test three months after treatment.

And in a special project by Public Health-Seattle & King County and private physicians, a patient treated for chlamydia or gonorrhea is given free antibiotics to give to his or her partner if the partner won't see a doctor. The program has resulted in about a 25 percent reduction in recurrence of the diseases, Golden said.

Osborn-O'Dom, whose clinic has tested more than 3,700 teenage girls since January, said many are stunned by a positive test: They may have only been trying out sex for the first time, or been drinking and used bad judgment, or not been aware they could be infected without symptoms.

Clinic workers give girls an overview of STDs on their first visit for any kind of care. They encourage a test if they come in for birth control or any reproductive-health issue. And they tell them about all the tests available for STDs.

"We are delighted when they come in to get checked and treated, because chlamydia is the No. 1 cause of infertility and ectopic [tubal] pregnancy," said the veteran nurse. "A lot of them are sexually active and not getting diagnosed."

Warren King: 206-464-2247 or wking@seattletimes.com